State of Washington Classified Job Specification
FINANCIAL SERVICES COUNSELOR
Class Series Concept
Determine eligibility for third-party reimbursement. Process and monitor Medical Assistance/Medicaid applications for patients.
Determine eligibility for third-party reimbursement and maintain patient account tracking system to monitor accounts.
Under general direction, contact third-party payors to obtain insurance eligibility and benefit information, estimate and collect deposits, and counsel patients regarding insurance coverage and hospital billing procedures.
Verify eligibility and benefits for third-party payors for planned and emergency admissions; validate prior authorizations for admission;
Estimate hospital charges, calculate anticipated reimbursement, and determine necessary deposits;
Counsel patients regarding their third-party coverage, financial responsibility, billing procedures;
Obtain detailed financial information, request deposits and make referrals to Medicaid Application Unit, Hill-Burton Program, and Hospitals Collection Department;
Review patient account summaries of unbilled charges, billings, payments and collection activity;
Obtain all claim forms, authorizations from third-party payors and signatures required for billing within department processing standards;
Counsel patients regarding financial arrangements for special programs and experimental protocols;
Review and monitor accounts for inpatients; initiate process billings;
Obtain or validate prior authorization for admission; monitor length of stay and approved days; report to Utilization Management for concurrent review activities;
Maintain and update billing requirement tracking system; Update and maintain demographic and financial information; enter this information on-line to the central ospital database;
Compose various correspondence related to reimbursement and billing procedures;
Assist patients in accessing hospital and community services by consulting and making referrals to social workers, patient care coordinators, nursing liaisons, and outside agencies;
Perform related duties as required.
There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.
Two years of college-level courses.
Two years of experience in a health care business office, medical insurance office, social services agency, or customer service position in a financial institution.
Class Specification History
New class code, formerly 6073 higher education, effective July 1, 2007.
Abolished; adopted August 13, 2015, effective August 14, 2015